Irritable Bowel Syndrome (4.2)

Question 1

What is IBS? what is it characterised by?

Answer 1

GI disorder characterised by abdominal pain and bloating, as well as changes in bowel movements

• Altered physiological function rather than identifiable structural or biochemical cause

> Chronic, intermittent, recurrent disorder that needs long term management

> no biological marker to confirm diagnosis

Question 2

What are some causes of IBS or proposed causes?

Answer 2

• Visceral hypersensitivity
• Increased gastrointestinal permeability and increased gut motility and secretion
• Post inflammation (infectious and non-infectious)
• Gut microflora
• Food allergy / intolerance
• Psychosocial factors

Question 3

What is the prevalence of IBS?

Answer 3

Affects 15-20% adults worldwide

• GP visits for IBS make up 12% of primary care visits
• Most complaint seen by gastroenterologists
• Males : Females 1:2
• Peak occurrence 3rd to 5th decade

Question 4

What are some signs and symptoms of IBS?

Answer 4

Abdominal pain

• Location often varies
• Described as dull cramping pain or sharp pain
• Lasts minutes to hours, often relieved by defecation or passing wind

Bloating

• With or without abdominal distension
• Worse by the end of the day
• Flatulence

Change of bowel habits

• Diarrhea, constipation, or both often mixed or alternating

other signs and symptoms include:

> nausea, feeling full soon after eating, mucus in stool, the sensation of incomplete evacuation after a bowel motion, excessive belching

Question 5

How to diagnose IBS?

Answer 5

• No standard diagnostic test
• Physical examination and detailed medical history
• Exclusion of other pathological disease such as celiac disease, inflammatory bowel disease, or colorectal cancer

> Faecal Occult Blood Test

> FBC, ESR, C-reactive protein, antibody testing for coeliac disease

• Rome IV Diagnostic Criteria

> Recurrent abdominal pain at least one day a week in the last three months associated with two or more of the following:

• Related to defecation
• Associated with a change in frequency of stool
• Associated with a change in the appearance of stool
• Onset of symptoms more than 6 months before diagnosis

Question 6

What are the types of IBS?

Answer 6

• Diarrhoea predominant (D-IBS)
• Constipation predominant (C-IBS)
• Mixed and alternating (M-IBS)

Question 7

For IBS;

A) who is the patient?

B) what are the symptoms

C) how long have the symptoms been present

D) action taken

E) medical conditions and medications

F) allergy

Answer 7

A)

• Common in people between 20-30 years old
• Individual aged 45 and above need to be referred to rule out organic bowel disease

B)

• Pain? Nature of pain?
• Changes in bowel habit from normal?
• Bloating or flatulence?
• “Non gut” symptoms?

C)

• IBS symptoms are periodic
• Chronic relapsing remitting
• How long and how frequent are the symptoms

D)

• Has it been diagnosed as IBS?
• Any previous treatment that is found to be effective?
• Lifestyle changes?

E)

• Are they on any medications that could have contributed to symptoms of IBS e.g. constipation caused by iron supplement
• Do they have any medical condition that exclude the use of IBS treatment such as BPH etc.

Question 8

What are some non pharmacological treatment for IBS

Answer 8

• Diet (low FODMAP) –> Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols diet

FODMAP are sugar that are poorly absorbed and produce gas and attract water in the large intestine

• Exercise
• Stress management
• Probiotics
• Hypnotherapy
• Cognitive behaviour therapy

Question 9

self-care for IBS

Answer 9

Try to identify and avoid IBS triggers

• Is it food related
• Is it precipitated by stress

Eating regular meals

• Try to avoid missing meal
• Eat slowly

Healthy diet

• Limit foods high in fat, sugar or salt

Limit alcohol intake

Increase fiber intake for C-IBS

• Slow increase with adequate fluid intake to prevent constipation

Exercise

Relaxation technique